From pancreas to pleura: Unraveling a rare complication

Pancreaticopleural fistulas (PPFs) are a rare and challenging condition in both clinical and diagnostic aspects. It is a rare complication of pancreatitis resulting from pancreatic collections communicating with the pleural cavity. They primarily cause respiratory system symptoms and pleural effusion. We present a case of a 30-year-old male with alcohol-induced pancreatitis presented with 2 months history of shortness of breath and cough. Chest radiograph demonstrated right massive pleural effusion. Repeated thoracentesis showed recurrent hemorrhagic pleural fluid with increased amylase and lipase. Computed tomography revealed no significant cause, and magnetic resonance cholangiopancreatography showed a fistulous tract between the pancreas and the right pleural cavity. The patient’s clinical presentation was misleading due to respiratory complaints, and a high clinical suspicion of PPF in recurrent massive hemorrhagic pleural effusion will lead to this diagnosis.